Connecting with Manitoba’s Health Professionals Issue 13, Winter 2011

Exercise and the Prevention of Cancer What You Should Know

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xercise is good for more than just your waistline and could play a significant role in the prevention of cancer, according to a physician from the University of Manitoba’s Department of Internal Medicine and Community Health Sciences. At the recent Cancer Day for Primary Care on January 14, 2011, Dr. Ryan Zarychanski noted that healthcare providers should reinforce the benefits of exercise, especially for patients at risk of breast, colon or endometrial cancer. “We all know it’s good for you. Cancer prevention is just another reason why people should be exercising,” Zarychanski said to a packed room of family physicians & nurse practitioners. Citing an American study that found 15-20% of cancer deaths are linked to obesity, Zarychanski expressed concern that obesity rates are on the rise among men and women. “There are many interdependent factors that lead to the diagnosis of cancer. It’s not just the result of eating more and exercising less,” said Zarychanski. Increasing obesity rates are occurring in the context of other changes such as urbanization, industrialization,

lack of physical activity, changing dietary choices and emotional stress. Although the exact mechanism of how exercise reduces cancer risk isn’t known, it is believed that exercise increases insulin sensitivity, decreases androgens and estrogens, increases sex hormone binding proteins, and decreases markers of chronic inflammation. Others have suggested that physical activity’s effects on hormone levels, immune function, and body weight may play a role. “A compelling weight of evidence shows us that exercise reduces the occurrence of breast and colon cancers” he said. Other studies have demonstrated an improved quality of life and improvements

in cancer survival in people already treated for cancer. Zarychanski noted that in over 70 separate epidemiologic studies involving breast cancer, 75% identified physical activity as a benefit in prevention. In colon cancer prevention, over 60 studies yielded a combined relative risk reduction of 2025% when physical activity played a part. In what is the first randomized trial in this field, the Canadian lead CHALLENGE trial will examine if physical activity can improve the survival of patients diagnosed with colon cancer. “The CHALLENGE trial will be the highest quality study ever conducted in this field, and we await the results of this study with great anticipation, said Dr. Zarychanski”. According to Zarychanski, the US Department of Health and several Canadian organizations have recommended 30 to 60 minutes of exercise a day or 4-7 hours of moderate to vigorous intensity activity every week. “Evidence shows that exercise is not only good for you, but appears to prevent a proportion of cancer and improve the survival of patient’s diagnosed with cancer. The message should be disseminated and reinforced.” 1

Cindy Allan, NP, works with a strong multidisciplinary team, at Access RiverEast, where professional development of one member of the team impacts clinical expertise of the group. Cindy plans to expand her knowledge of pain and symptom management as it relates to cancer, strengthen a measured approach to diagnosing and working up blood disorders, and navigating through pathology reports for various cancers. Karen Juce, MD, is already considered a rich resource for dermatology consultation in Hamiota for western Manitoba. Dr. Juce will work with Dr. Marni Wiseman in CCMB Melanoma clinics and in private practice to improve diagnosis, detection and therapy of cutaneous malignancy and provide enhanced clinical service to her region. Audra Nesbitt-Hume, RN, says that taking the ONDEC - Oncology Nursing Distance Education Course and Canadian Oncology Nursing Certification (CONC) exam “will permit me to be an oncology resource to my colleagues, (and) a well informed educator. It will enable me to efficiently and effectively coordinate their care and guide them and their family on their cancer journey.” Richard Van Gend, MD, provides cancer care through the Pinawa Community Cancer Program (CCP) and primary care out of the Lac du Bonnet District Health Centre. Dr. Van Gend would like to carry out a comprehensive literature search/review of cancers seen in the CCP, review hematological disorders and spend time in the pain and symptom clinics at CCMB.

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Announcing… Winners of the 2010-11 Community Cancer Care Scholarships

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he Community Cancer Programs Network (CCPN) and Uniting Primary Care and ONcology (UPCON) are pleased to announce the winners of the Community Cancer Care scholarships for 2010-2011. These scholarships are designed for family physicians and nurse practitioners in primary care practice, and health care professionals affiliated with the CCPN. Winners participate in an individualized education program that includes one to two weeks of clinical training or funding for oncology distance education courses. Generously funded by the CancerCare Manitoba Foundation, scholarships were awarded to the following: Clinical Training at CCMB: Cindy Allan, Nurse Practitioner, Access River East Winnipeg,  Karen Juce, Family Physician, Hamiota Richard Van Gend, Family Physician, Pinawa Community Cancer Program (CCP)  Diana Duncan, Pharmacist, Portage CCP Oncology Distance Education:   Audra Nesbitt-Hume, RN, Eriksdale Cancer Resource and Support Program Brenda Puhach, RN, Russell CCP Melanie Bernas, RN, Selkirk CCP We congratulate them and wish them well as they use this unique opportunity to pursue their continuing education in oncology.

Record breaking attendance at 7th Annual Cancer Day for Primary Care!

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ancerCare Manitoba and UPCON (Uniting Primary Care and ONcology) in conjunction with the University of Manitoba Continuing Professional Development (CPD) Department presented Cancer Day for Primary Care on January 14, 2011 at the Gaspard Theatre, Basic Medical Sciences. Attendance has been tallied at 261, including five sites connecting via MBTelehealth linking more than 28 primary care providers from outside Winnipeg to the conference site. The full day symposium featured presentations by Dr. Vallerie Gordon, Dr. Jane Griffith, Dr. Gary Harding, Dr. Blair Henderson, Dr. Robert Lotocki, Dr. Garry Schroeder, Dr. Marni Wiseman, and Dr. Ryan Zarychanski who shared perspectives on prevention and screening, treatment innovations, and on follow-up issues for the major cancer sites. Visit www.umanitoba.ca/cme to view speakers’ presentations.

Ask the Cancer Expert

Brain Fog and Cancer by Katherine Gottzman, MSW

Vallerie Gordon BSc, MD, FRCPC Medical Oncology Fellow CancerCare Manitoba

What is the evidence: Is it real? Cancer patients have been reporting cancer related cognitive changes for many years, but it is only during the last 10-15 years that the issue has become a focus of research. Frustratingly for patients, skepticism has existed regarding whether these reported cognitive changes are “real”. Recent neuroimaging studies, reporting structural and functional changes in the brains of cancer patients, present tangible evidence that cognitive changes do occur.

Cause and natural history Initially patients coined the terms chemo brain and chemo fog to describe the cognitive changes they noticed after receiving chemotherapy. Over time it became evident that cancer patients who had never received chemotherapy were also reporting cognitive changes, leading to the use of the terms cancer treatment associated cognitive change or cancer related brain fog. Patients report problems with short term memory, concentration, attention, word retrieval, and multi-tasking, which affect their quality of life. Cancer related cognitive change remains under researched and current studies do not provide definitive answers about its cause. Scientists believe the cause may be both host related and disease related and may involve factors such as: cancer treatment; genetic predisposition; depression, anxiety and fatigue; cytokines; vascular effects; endogenous hormones; and pre-existing conditions.

Does brain fog resolve over time? Although for most individuals these cognitive changes do improve over time, for a small subset of cancer patients the impairment may be sustained and impact their ability to function at work and home.

What are the treatments? There are very few evidence based interventions available to treat brain fog because early research has focused on documenting cognitive change and exploring causal factors. Although researchers have begun to examine the use of pharmacologic interventions, these investigations are at an early stage. Currently, suggestions for treatment focus on health promotion, cognitive training, compensatory strategies, and restorative activities.

What can we do to help patients? Health care providers can be helpful to patients by validating patient concerns, increasing access to neuropsychological testing, making patients aware of available treatments and resources, providing emotional support, and nurturing hope for improvement. What resources are out there? Patient & Family Support Services clinicians have received training from neuropsychologist Dr. Heather Palmer (www. maximumcapacity.org) to offer an evidence based program “Coping with Brain Fog” to cancer patients at CCMB. The popular and well received program offers information and strategies to manage cancer related cognitive changes. An upcoming session is scheduled to begin in January and is available through Manitoba Telehealth, making this program accessible for both urban and rural Manitobans. References available from the Editor.

Question:

My patient has asked for a “blood test to check for cancer”. Is there any utility in doing a panel of tumour markers in asymptomatic patients?

Answer:

Tumour markers are useful only in select settings, and most do not help with diagnosis, but rather assist with following the disease after diagnosis. In patients undergoing multimodal mass screening tests, the PCLO (Prostate, Colorectal, Lung and Ovarian Cancer Screening Trial) found that the cumulative risk of having a false positive result after 14 multimodal screening tests is 60.4% in men, and 48.8% in women. This led to invasive and potentially morbid diagnostic testing in 28.5% of men, and 22.1% of women. Current guidelines do not suggest that there is benefit to any screening tumour markers in asymptomatic patients other than possibly PSA testing. I say possibly, because there is potential harm, and also potential benefit to PSA testing. The testing may lead to detecting and treating a prostate cancer that might otherwise have never caused the patient symptoms or a decrease in longevity. It could also lead to anxiety and decreased quality of life. However, detection of disease earlier may also lead to improved prostate cancer specific survival. The most useful tumour marker in family practice is the CEA, but only when used for patients with known stage II or III colorectal cancer for surveillance for recurrence of their disease. It is recommended by CCMB for use every 3 months for the first 3 years after surgery to detect asymptomatic recurrences that may sometimes be amenable to resection, potentially curing the disease. 3

Help for patients’ appearance-related side effects CancerCare Manitoba’s Guardian Angel Caring Room offers programs and resources to help with patients’ appearance-related side effects.

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anitobans who are experiencing hair loss due to cancer treatment may choose one wig and three head coverings to use as long as needed. There is a large inventory of wigs available to choose from in many different styles and colors. Stoma covers are available in various sizes and colors for individuals who have had a laryngectomy. The Look Good Feel Better program is 2-hour workshop which addresses the appearance-related side effects of cancer and its treatment. These services are FREE and are available at two CancerCare Manitoba sites in Winnipeg; MacCharles site

at 675 McDermot and the recently renovated CancerCare location in the St. Boniface Hospital. Please encourage your patient’s to call for an appointment or to register for a program at 787-4180 or 1-800-561-1026.

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Social workers and nurse educators “I think it’s excellent. What was most at CCMB facilitate the sessions, and helpful was sharing where you’re at CCMB experts provide content specific now and the progress. Reminds (you) presentations. A unique feature of the to look at your progress and not who weekly is the 30 minutes of guided you were. Gave me ways to deal with exercise led by an exercise specialist. fears.” The pilot studies have Physician approval to indicated positive results. participate in the physical “What was most The program was run at helpful was sharing activity component of CancerCare Manitoba in the where you’re at the program is required. Fall, with another session Registration is through now…it gave me currently underway; the CCMB’s Patient and new ways to deal next session is planned Family Support Services at with fears.” for late spring. Participant 787-2109. All sessions are surveys indicate a high level free of charge and include a of satisfaction. Here’s what workbook because of financial support participants had to say: from the CancerCare Manitoba Foundation. “I find the discussions and ideas people share are very helpful.”

ancerCare Manitoba has implemented a new program for cancer survivors called Cancer Transitions. Six weekly sessions, each 2½ hours, focus on topics such as: Taking Control of Survivorship, Exercise for Wellness, Emotional Health and Well-Being, Nutrition Beyond Cancer, Medical Management and Moving Beyond Treatment. The program helps patients transition into “survivorship” and find their “new normal”. It is designed for those seeking direction and support following treatment, and/or who are looking for specific information on health and wellness.

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Shown at right: recently renovated wig and head covering service located at St. Boniface CancerCare unit.

It matters to

You.

Breast cancer screening can save lives! 50 or over? Book your mammogram today.

788-8000

cancercare.mb.ca

Record number of breast cancers detected by mammography in 2010 T

he Manitoba Breast Screening Program (MBSP) detected a record 258 breast cancers by screening 45,800 women between April 1 2009 and March 31 2010! The Program actively invites women, provides a mobile service and produces and distributes screening information. In order for the program to find breast cancers, women need to return on a regular basis but many women seem to think once is enough. First timers are less likely to return than those women who have made it a part of their health care routine. Only 71% of first Why aren’t some timers return within 30 months of their previous visit patients returning to whereas 85% of women return after having subsequent breast screening? screens. Why aren’t some patients returning to breast screening? Surveys by Statistics Canada give three main reasons why women don’t attend for a mammogram: they didn’t think it was important, they didn’t get around to it, or their doctor didn’t think it was necessary. The influence and guidance of family physicians, nurse practitioners and primary care providers is critical in encouraging women to participate in the MBSP. Women need to know that routine screening is important, be reminded regularly about doing it and know that once is not enough. To order resources or for further information contact: (204) 788-8000 or Toll Free 1-800-903-9290.

Stick Tricks: Helping patients with FOBT collection Colon Check Manitoba has practical tools that can help increase your patient’s compliance with the FOBT home screening test such as: • • • •

Large FOBT demonstration card Large-print FOBT instruction pamphlet FOBT Instructional 5 minute Video Calendar stickers for managing FOBT restrictions

Remember March is National Colorectal Cancer Awareness Month! Call today to order or visit our website www.coloncheckmb.ca Cancer screening can save lives! Take time to check.

Pap Test Week paving the way for Year Round Access Team! In its eighth year running, Manitoba Pap Test Week 2010 can report its highest attendance ever! Seventy-nine sites hosted nearly 150 walk-in Pap clinics for 1,750 women; over 60% of the women were overdue for a Pap test. Keeping with the Manitoba Cervical Cancer Screening Program’s (MCCSP) mandate to target Manitoba’s under screened women, the program is relying on its partnerships to continue offering Pap clinics year round, outside of Pap Week. The program’s new invitation letter sends direct mail to Manitoba’s most at-risk women, encouraging them to get a Pap test, and where they can access service in their community. “It’s been a smooth process”, explains Lesley Dyck, Health Promotion Specialist. “Because so many Manitoba clinics and nursing stations are familiar with offering Pap clinics during Manitoba Pap Test Week, they are primed and ready to offer service in conjunction with our invitation letter initiative.” Last spring, 41 sites opened their doors to women who received an invitation letter for a Pap test. The program is gearing up for the second round of invites this spring. To learn more about the MCCSP’s Year Round Access Team, or to register, contact Lesley Dyck at (204) 788-8627 or lesley.dyck@ cancercare.mb.ca

Editor Jeff Sisler, MD MClSc FCFP Director, Primary Care Oncology CancerCare Manitoba Phone 204-787-3595 [email protected]

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Interlake Regional Health Authority

Eriksdale cancer resource first of its kind in Manitoba

Remember the

‘Bear Facts!’

Reduce your cancer risk by up to 50%: 1. Be Tobacco Free! 2. Eat Well! 3. Shape Up! 4. Cover Up! 5. Check Up! L to R: Erin Roehl, Zofia Perlkowski and Audra Nesbitt-Hume.

For more information, or to order free

fridge magnets, brochures and colouring Residents and health care providers of the Interlake can now access pages, go to www.cancercare.mb.ca cancer navigation and supportive care services throughout the entire 204-787-4143/1-877-407-2223 cancer patient journey, thanks to the establishment of a Community Cancer Resource and Support Program in Eriksdale. Located within the new Eriksdale Wellness Centre, this initiative is a Remember Bear Facts ad.indd Manitoba 1 5/30/07 8:25:27 am Western unique addition to the 16 Community Cancer Program Network (CCPN) sites in rural Manitoba. For the Interlake Regional Health Authority, this Cancer Centre Set to program will complement the long-standing cancer care at Gimli and Open in Brandon Selkirk Community Cancer Programs. For Manitobans, this program is an expression of an enhancement of services across the province Construction is nearly complete on the $24-million, Western “Cancer is a complex illness and the cancer care system is equally Manitoba Cancer Centre complex,” said Ruth Loewen, Director, CCPN. “Navigation services will (WMCC) that will provide help patients and their families find their way. Family physicians and residents of the western regions other care providers will also be able to access navigation services to help of Manitoba with radiation them coordinate community and cancer care.” therapy closer to home, along The team that welcomes self-referrals and referrals from all providers for with expanded chemotherapy patients and families includes Audra Nesbitt-Hume, R.N., B.N., cancer and outpatient care services for patient navigator; Zofia Perlkowski, M.S.W., R.S.W., cancer patient and cancer patients and families. family support worker; and Erin Roehl, program assistant. With the addition of a linear The team’s expertise is available from the time someone has a diagnosis accelerator for state of the art that includes suspicion of cancer to anywhere along the cancer radiation therapy, the WMCC continuum including survivorship, palliative care and bereavement. also features offices for a Together, they work to help meet the needs of individual patients and pharmacist and a dietician as help to overcome the challenges people face when they have cancer and well as support services for live in rural Manitoba. emotional, social and spiritual For assistance, call the Eriksdale Team @ (204) 739-2777. health for patients and their families; the introduction of patient navigation services; an outpatient clinic with work areas and exam rooms; a quiet area for patients and family; and volunteer space. Look for photos of the grand opening in the next issue of CancerTalk!

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